Death is inevitable. We realise it the day we are born. But it is when all means needed to save a person have exhausted that we can hold this dictum true. We as public cannot keep track of all those who die but all of us do come to know immediately about the death of our near ones as well as our neighbours. About others not so near or not known at all we learn from the obituary column of newspapers or through acquaintances. There is a separate department of ‘Births and Deaths’ in municipal corporations that has the responsibility of documenting both births and deaths.
Well it is anybody’s guess in Kashmir, that the number of people dying is far greater in winter than rest of the year. This all of you will vouch for, from within your vicinity and beyond . Every now and then, come Chillai Kalan, in our neighborhood we have to attend a Fatheha or a Jinaza and sometimes it may be for relatives living near or far. Most Kashmiri households have a routine of attending the condolence meet much more during winter than in other seasons. And as many Kashmiris are outside the country or move out to the plains in winter, the first thing they do on their comeback is to go to the relatives, neighbors and friends who have lost someone for condolences and more.
It is not just an observation but there is data to suggest this increased winter mortality. All the leading newspapers of Kashmir report a measurable increase in their content on obituary section in the harsh winter months. From half a page the obituary column expands to almost two full pages and more during the winter months compared to the summer and spring times. The data from leading hospitals as well as the Births and Deaths department confirms the findings that in winter (December to March) more people die. Undoubtly the mortality is exorbitantly higher in cold months than the hot summer season. In particular it is the elderly who get the call and succumb due to a multitude of reasons (the young most of the time get killed in Kashmir). Statistically the elderly have seasonal variation in dying, with highest deaths recorded in winter.
This high winter mortality is not surprising and doesn’t happen in Kashmir only as this phenomenon has been observed in many places with harsh winters compared to other seasons. Take Northern US, most EU countries, England and Wales, Iran, HongKong- all these places have scientifically demonstrated this phenomenon and attributed it to a variety of reasons. Be it the exacerbation of chronic disease, higher incidence of infection (viral or bacterial), higher cardio and cerebrovascular events. Cold may impair some physiological processes and this will predispose to enhanced chances of infections, higher blood pressure and enhanced rate of thrombosis and vasoconstriction which may exacerbate coronary and cerebral ischemia, leading to increased mortality especially in elderly. Also in affluent nations cold housing has been seen as a leading contributor of excess winter death (an aspect least realized here).
Same causes may be attributable here but with few added reasons as well. Be it inadequate and inappropriate health care facilities, late referral, delay and lag by patient or his attendants in seeking timely and proper medical advice due to the harsh climatic conditions, lack of immunization policy in adults and elderly, clustering and thence spread of infections rampantly, epidemic or near epidemic of flu, a question about efficacy of drugs is always suspect, inadequate and bad power supply which may result in poor insulation, malfunctioning of certain necessary medical equipments, improper and ill designed housing. Most of these deaths may be inevitable and do have scientific basis but many a times the deficiencies within the system do worsen the scenario. With more people now living to age 70 and beyond, maybe the numbers are high for this reason as well.
Government has to take measures that help the elderly in their health and surroundings so that preventable aspects that contribute to death are avoided. Social care workers should do a door to door survey that pinpoints very elderly people who may be in need of being helped rather than asking for same. We should devise facilities at providing health care in very elderly at the doorstep rather in hospital centers. Both the authorities as well as people need to ‘winterize’ at social, economic and health care level.
Lack of knowing about the reason of death is a negative for overall implementation policy. We in the Departments of Medicine, Hospital Administration and Social and Preventive Medicine at SKIMS and SMHS can formulate a research program to study the pattern, causes and preventive aspects of this excessive mortality. And hope that the same will be implemented by the concerned and responsible authorities. Till then we will have to continue with this unpleasant and unwanted trend. Just as I finished writing this column, I stand informed of another elderly neighbor succumbing to the killer winter.
(Dr Muzafar Maqsood Wani is consultant Nephrologist, SKIMS, Soura)